Learning Curve Analysis of Intracorporeal Cuff Suturing During Robotic Single-Site Total Hysterectomy

Study Objective: To analyze the learning curve of intracorporeal cuff suturing during robotic single-site total hysterectomy. Design: Retrospective study (Canadian Task Force classification Setting: University hospital. Patients: Twenty-four patients with benign indications for hysterectomy. Interventions: Twenty-four patients who underwent robotic single-site total hysterectomy to treat benign indications were included in the study. Surgical procedures were performed by a single surgeon with extensive experience in laparoscopy, using the single-site platform of the da Vinci Surgical System. All vaginal cuffs were closed intracorporeally using semi-rigid single-site instruments. Measurements and Main Results: An exponential learning curve technique was used to analyze the learning curve. The overall mean (SD) vaginal cuff closure time was 23.2 (7) minutes. Learning curve analysis revealed a decrease in vaginal closure time after 14 procedures. Conclusions: An experienced robotic surgeon requires approximately 14 procedures to achieve proficiency in intracorporeal cuff suturing during robotic single-site total hysterectomy. Novel instruments that create perfect triangulation are needed to overcome the current challenges of suturing and to shorten operative time. (C) 2015 AAGL. All rights reserved.